Food Poisoning, Bacterial

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Basics

Description

  • Results from the consumption of contaminated food or water
  • Symptoms commonly include vomiting, diarrhea, dehydration, abdominal discomfort, and fever (1).
  • Foodborne illness may be caused by bacterial, parasitic, or viral infection (2).

Epidemiology

  • The cause is unclear in up to 80% of foodborne illness.
  • Bacterial pathogens most commonly contributing to foodborne illness are Salmonella (nontyphoidal), Campylobacter, Clostridium perfringens, Staphylococcus aureus, Listeria monocytogenes, and Escherichia coli (1).
  • Norovirus is the most common viral cause of foodborne illness in the United States (3).

Incidence
Roughly 1 in 6 Americans (48 million) become ill, 128,000 are hospitalized, and 3,000 die of foodborne diseases annually.

Etiology and Pathophysiology

  • Short incubation period (1 to 6 hours)
    • Bacillus cereus toxin
      • Toxin can tolerate high temperatures
      • Food sources: improperly cooked rice/fried rice and red meats (2)
      • Symptoms: sudden onset of severe nausea. Vomiting and diarrhea may or may not be present.
    • S. aureus (1)
      • Toxin mediated
      • Food sources: nonrefrigerated or improperly refrigerated meats and potato and egg salads
      • Symptoms: sudden onset of severe nausea and vomiting. Abdominal cramps and fever may be present.
  • Medium incubation period (8 to 16 hours)
    • B. cereus (1)
      • Food sources: meat, stews, gravy, vanilla sauce
      • Symptoms: watery diarrhea, abdominal cramps, nausea
    • C. perfringens (1,2)
      • Food sources: dry/precooked or undercooked meats, home-canned goods
      • Symptoms: watery diarrhea, nausea, abdominal cramps
  • Long incubation period (>16 hours)
    • Toxin-producing organisms:
      • Clostridium botulinum (1)
        • Food source: commercially canned or improperly home-canned foods
        • Symptoms: vomiting, diarrhea, slurred speech, diplopia, dysphagia, and descending muscle weakness/flaccid paralysis
      • Enterohemorrhagic E. coli (e.g., 0157:H7) (1,2)
        • Food sources: undercooked ground beef, juice, unpasteurized milk, raw produce, and contaminated water
        • Risk factors: childcare centers, nursing homes, extremes of age
        • Symptoms: severe diarrhea that often becomes bloody, abdominal pain, vomiting
      • Enterotoxigenic E. coli (“traveler’s diarrhea”) (4)
        • Food sources: food or water contaminated by human feces
        • Symptoms: watery diarrhea, abdominal cramps, tenesmus, fecal urgency, and vomiting
      • Vibrio cholerae (2)
        • Food sources: contaminated water, fish, and shellfish, especially food sold by street vendors
        • Symptoms: profuse watery “rice water” diarrhea and vomiting, which can lead to severe dehydration and rapid death
    • Invasive organisms
      • Salmonella, nontyphoidal (1,2,3)
        • Food sources: contaminated eggs, poultry; unpasteurized milk or juice, cheese; contaminated raw fruit and vegetables; and contaminated peanut butter
        • Risk factors: contact with animals
        • Symptoms: small volume, mucopurulent and possibly bloody diarrhea; fever; abdominal cramps; vomiting
      • Campylobacter jejuni (1,2)
        • Food sources: raw and undercooked poultry, unpasteurized milk, and contaminated meats
        • Symptoms: diarrhea (possibly bloody), cramps, vomiting, fever
      • Shigella (1,2)
        • Food sources: contaminated water, raw produce, uncooked foods, foods handled by infected food worker
        • Risk factors: Men who have sex with men (MSM)
        • Symptoms: abdominal cramps, fever, mucopurulent and bloody diarrhea
      • Vibrio parahaemolyticus (1,2)
        • Food source: undercooked or raw seafood, especially shellfish
        • Risk factors: cirrhosis
        • Symptoms: nausea, vomiting, diarrhea, abdominal pain
      • Vibrio vulnificus (1,2)
        • Food source: undercooked or raw seafood, particularly oysters
        • Symptoms: vomiting, diarrhea, abdominal pain, bacteremia, wound infections; can be fatal in patients with liver disease or those who are immunocompromised
      • Yersinia enterocolitica (2)
        • Food sources: undercooked beef and pork, unpasteurized milk, tofu, contaminated water
        • Risk factors: cirrhosis, hemochromatosis, blood transfusion
        • Symptoms: abdominal pain, fever, diarrhea (possibly bloody), vomiting
      • L. monocytogenes (1)
        • Food sources: unpasteurized/contaminated milk, soft cheese, and processed deli meats
        • Risk factors: pregnancy
        • Symptoms: nausea, vomiting, fever, watery diarrhea; pregnant women may have a flu-like illness leading to premature delivery or stillbirth; immunocompromised patients may develop meningitis and bacteremia.

Risk Factors

  • Recent travel to a developing or underdeveloped countries (3)
  • Food handlers, childcare attendees, nursing home residents, recently hospitalized patients or patients recently exposed to antibiotics (2)
  • Altered immunity due to underlying disease or use of certain medications, including antacids, H2 blockers, and proton pump inhibitors (3)
  • Cross-contamination and subsequent ingestion of improperly prepared and stored foods

General Prevention

  • When preparing food:
    • Wash hands, cutting boards, and food preparation surfaces before and after preparing each item
    • Wash fresh produce thoroughly before consuming
    • Keep raw meat, poultry, fish, and their juices away from other food (e.g., salad). Wear gloves when handling raw meats (5).
    • Do not put cooked protein or washed produce into containers or on surfaces where unwashed or raw food was stored.
    • Thoroughly cook meat to the following internal temperatures:
      • Fresh beef, veal, pork, and lamb: 145°F
      • Ground meats and egg dishes: 160°F
      • Poultry: 165°F
      • Cook eggs thoroughly until the yolk is firm.
      • Seafood: 145°F
    • Refrigerate leftovers within 2 to 3 hours in clean, shallow, covered containers. If the temperature is >90°F, refrigerate within 1 hour.
  • When traveling to underdeveloped countries:
    • Eat only freshly prepared foods.
    • Avoid beverages and foods prepared with nonpotable water.
    • Other risky foods include raw or undercooked meat and seafood, unpeeled raw fruits, and vegetables.
    • Bottled, carbonated, and boiled beverages are generally safe to drink.
  • Improved hygiene and sanitation reduces the risk of traveler’s diarrhea. The prevention strategy “Boil it, Cook it, Peel it, or Forget it” is easy to remember and may be of use, although there is inconsistent and limited evidence to overall benefit (4).
  • Chemoprophylaxis for traveler’s diarrhea is recommended for high-risk travelers (e.g., immunocompromised) (4).

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Basics

Description

  • Results from the consumption of contaminated food or water
  • Symptoms commonly include vomiting, diarrhea, dehydration, abdominal discomfort, and fever (1).
  • Foodborne illness may be caused by bacterial, parasitic, or viral infection (2).

Epidemiology

  • The cause is unclear in up to 80% of foodborne illness.
  • Bacterial pathogens most commonly contributing to foodborne illness are Salmonella (nontyphoidal), Campylobacter, Clostridium perfringens, Staphylococcus aureus, Listeria monocytogenes, and Escherichia coli (1).
  • Norovirus is the most common viral cause of foodborne illness in the United States (3).

Incidence
Roughly 1 in 6 Americans (48 million) become ill, 128,000 are hospitalized, and 3,000 die of foodborne diseases annually.

Etiology and Pathophysiology

  • Short incubation period (1 to 6 hours)
    • Bacillus cereus toxin
      • Toxin can tolerate high temperatures
      • Food sources: improperly cooked rice/fried rice and red meats (2)
      • Symptoms: sudden onset of severe nausea. Vomiting and diarrhea may or may not be present.
    • S. aureus (1)
      • Toxin mediated
      • Food sources: nonrefrigerated or improperly refrigerated meats and potato and egg salads
      • Symptoms: sudden onset of severe nausea and vomiting. Abdominal cramps and fever may be present.
  • Medium incubation period (8 to 16 hours)
    • B. cereus (1)
      • Food sources: meat, stews, gravy, vanilla sauce
      • Symptoms: watery diarrhea, abdominal cramps, nausea
    • C. perfringens (1,2)
      • Food sources: dry/precooked or undercooked meats, home-canned goods
      • Symptoms: watery diarrhea, nausea, abdominal cramps
  • Long incubation period (>16 hours)
    • Toxin-producing organisms:
      • Clostridium botulinum (1)
        • Food source: commercially canned or improperly home-canned foods
        • Symptoms: vomiting, diarrhea, slurred speech, diplopia, dysphagia, and descending muscle weakness/flaccid paralysis
      • Enterohemorrhagic E. coli (e.g., 0157:H7) (1,2)
        • Food sources: undercooked ground beef, juice, unpasteurized milk, raw produce, and contaminated water
        • Risk factors: childcare centers, nursing homes, extremes of age
        • Symptoms: severe diarrhea that often becomes bloody, abdominal pain, vomiting
      • Enterotoxigenic E. coli (“traveler’s diarrhea”) (4)
        • Food sources: food or water contaminated by human feces
        • Symptoms: watery diarrhea, abdominal cramps, tenesmus, fecal urgency, and vomiting
      • Vibrio cholerae (2)
        • Food sources: contaminated water, fish, and shellfish, especially food sold by street vendors
        • Symptoms: profuse watery “rice water” diarrhea and vomiting, which can lead to severe dehydration and rapid death
    • Invasive organisms
      • Salmonella, nontyphoidal (1,2,3)
        • Food sources: contaminated eggs, poultry; unpasteurized milk or juice, cheese; contaminated raw fruit and vegetables; and contaminated peanut butter
        • Risk factors: contact with animals
        • Symptoms: small volume, mucopurulent and possibly bloody diarrhea; fever; abdominal cramps; vomiting
      • Campylobacter jejuni (1,2)
        • Food sources: raw and undercooked poultry, unpasteurized milk, and contaminated meats
        • Symptoms: diarrhea (possibly bloody), cramps, vomiting, fever
      • Shigella (1,2)
        • Food sources: contaminated water, raw produce, uncooked foods, foods handled by infected food worker
        • Risk factors: Men who have sex with men (MSM)
        • Symptoms: abdominal cramps, fever, mucopurulent and bloody diarrhea
      • Vibrio parahaemolyticus (1,2)
        • Food source: undercooked or raw seafood, especially shellfish
        • Risk factors: cirrhosis
        • Symptoms: nausea, vomiting, diarrhea, abdominal pain
      • Vibrio vulnificus (1,2)
        • Food source: undercooked or raw seafood, particularly oysters
        • Symptoms: vomiting, diarrhea, abdominal pain, bacteremia, wound infections; can be fatal in patients with liver disease or those who are immunocompromised
      • Yersinia enterocolitica (2)
        • Food sources: undercooked beef and pork, unpasteurized milk, tofu, contaminated water
        • Risk factors: cirrhosis, hemochromatosis, blood transfusion
        • Symptoms: abdominal pain, fever, diarrhea (possibly bloody), vomiting
      • L. monocytogenes (1)
        • Food sources: unpasteurized/contaminated milk, soft cheese, and processed deli meats
        • Risk factors: pregnancy
        • Symptoms: nausea, vomiting, fever, watery diarrhea; pregnant women may have a flu-like illness leading to premature delivery or stillbirth; immunocompromised patients may develop meningitis and bacteremia.

Risk Factors

  • Recent travel to a developing or underdeveloped countries (3)
  • Food handlers, childcare attendees, nursing home residents, recently hospitalized patients or patients recently exposed to antibiotics (2)
  • Altered immunity due to underlying disease or use of certain medications, including antacids, H2 blockers, and proton pump inhibitors (3)
  • Cross-contamination and subsequent ingestion of improperly prepared and stored foods

General Prevention

  • When preparing food:
    • Wash hands, cutting boards, and food preparation surfaces before and after preparing each item
    • Wash fresh produce thoroughly before consuming
    • Keep raw meat, poultry, fish, and their juices away from other food (e.g., salad). Wear gloves when handling raw meats (5).
    • Do not put cooked protein or washed produce into containers or on surfaces where unwashed or raw food was stored.
    • Thoroughly cook meat to the following internal temperatures:
      • Fresh beef, veal, pork, and lamb: 145°F
      • Ground meats and egg dishes: 160°F
      • Poultry: 165°F
      • Cook eggs thoroughly until the yolk is firm.
      • Seafood: 145°F
    • Refrigerate leftovers within 2 to 3 hours in clean, shallow, covered containers. If the temperature is >90°F, refrigerate within 1 hour.
  • When traveling to underdeveloped countries:
    • Eat only freshly prepared foods.
    • Avoid beverages and foods prepared with nonpotable water.
    • Other risky foods include raw or undercooked meat and seafood, unpeeled raw fruits, and vegetables.
    • Bottled, carbonated, and boiled beverages are generally safe to drink.
  • Improved hygiene and sanitation reduces the risk of traveler’s diarrhea. The prevention strategy “Boil it, Cook it, Peel it, or Forget it” is easy to remember and may be of use, although there is inconsistent and limited evidence to overall benefit (4).
  • Chemoprophylaxis for traveler’s diarrhea is recommended for high-risk travelers (e.g., immunocompromised) (4).

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